OUR LOCATIONS

Medicare Guidelines – Allied

All examinations performed by North Coast Radiology are done so in observance of the Medicare Benefits Schedule. The Medicare Benefits Schedule provides criteria which determine if rebates offered by Medicare can be accessed by patients.

 

For a patient to be eligible for a Medicare rebate there are certain criteria that all referrals must display.

– Referrer name, provider number, contact details and signature of the referrer
– Examination requested
– All relevant clinical history

 

Click on the tab with Modality you want Medicare rule information about. If you are a GP click here for Medicare information.

 

For detailed MBS information about a CMBS item click here for the search screen.

Chiropractors

ItemDescriptionLimitations
57712x-ray - hip joint
57715x-ray - pelvic girdle
58100x-ray - cervical spine
58103x-ray - thoracic spine
58106x-ray - lumbosacral spine
58109x-ray - sacrococcygeal spine
58112x-ray - spine; two examinations of the kind referred to in items 58100, 58103, 58106 and 58109
58120*x-ray - spine, four regions, cervical, thoracic, lumbosacral and sacrococcygeal*Items 58120 or 58121(not both) limitation is one per calendar year
58500x-ray - chest (limited rebate)
57706x-ray - clavicle (limited rebate)
57518x-ray - foot, ankle, leg, knee or femur (limited rebate)
57524x-ray - foot and ankle, ankle and leg, leg and knee or knee and femur (limited rebate)
57506x-ray - hand, wrist, forearm, elbow and humerus (limited rebate)
57512x-ray - hand and wrist, hand wrist and forearm, forearm and elbow or elbow and humerus (limited rebate)
57700x-ray - shoulder or scapula (limited rebate)

Dental Practioners (all)

ItemDescriptionLimitations
57509x-ray - hand, wrist, forearm, elbow or humerus
57515x-ray - hand and wrist or hand, wrist and forearm or forearm and elbow or elbow and humerus
57521x-ray - foot, ankle, leg, knee or femur
57527x-ray - foot and ankle, or ankle and leg, or leg and knee or knee and femur
57901x-ray skull
57902x-ray - cephalometry
57903x-ray sinuses
57918x-ray - salivary calculus
57906x-ray - mastoids
57921x-ray - nose
57909x-ray - petrous temporal bones
57912x-ray - facial bones
57915x-ray - mandible
57518x-ray - foot, ankle, leg, knee or femur (limited rebate)
57524x-ray - foot and ankle, ankle and leg, leg and knee or knee and femur (limited rebate)
57506x-ray - hand, wrist, forearm, elbow and humerus (limited rebate)
57512x-ray - hand and wrist, hand wrist and forearm, forearm and elbow or elbow and humerus (limited rebate)
57700x-ray - shoulder or scapula (limited rebate)

Midwives

ItemDescriptionLimitations
55700the pregnancy is dated at less than 12 weeks gestation and one or more of the following conditions are present:
  1. hyperemesis gravidarum;
  2. diabetes mellitus;
  3. hypertension;
  4. toxaemia of pregnancy;
  5. liver or renal disease;
  6. autoimmune disease;
  7. cardiac disease;
  8. alloimmunisation;
  9. maternal infection;
  10. inflammatory bowel disease;
  11. bowel stoma;
  12. abdominal wall scarring;
  13. previous spinal or pelvic trauma or disease;
  14. drug dependency;
  15. thrombophilia;
  16. significant maternal obesity;
  17. advanced maternal age;
  18. abdominal pain or mass;
  19. uncertain dates;
  20. high risk pregnancy;
  21. previous post dates delivery;
  22. previous caesarean section;
  23. poor obstetric history;
  24. suspicion of ectopic pregnancy;
  25. risk of miscarriage;
  26. diminished symptoms of pregnancy;
  27. suspected or known cervical incompetence;
  28. suspected or known uterine abnormality;
  29. pregnancy after assisted reproduction;
  30. risk of fetal abnormality
Pregnancy < 12 weeks only
57707the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84mm; and nuchal translucency measurement is performed to assess the risk of fetal abnormality; and one or more of the following conditions are present:
     
  1. hyperemesis gravidarum;
  2. diabetes mellitus;
  3. hypertension;
  4. toxaemia of pregnancy;
  5. liver or renal disease;
  6. autoimmune disease;
  7. cardiac disease;
  8. alloimmunisation;
  9. maternal infection;
  10. inflammatory bowel disease;
  11. bowel stoma;
  12. abdominal wall scarring;
  13. previous spinal or pelvic trauma or disease;
  14. drug dependency;
  15. thrombophilia;
  16. significant maternal obesity;
  17. advanced maternal age;
  18. abdominal pain or mass;
  19. uncertain dates;
  20. high risk pregnancy;
  21. previous post dates delivery;
  22. previous caesarean section;
  23. poor obstetric history;
  24. suspicion of ectopic pregnancy;
  25. risk of miscarriage;
  26. diminished symptoms of pregnancy;
  27. suspected or known cervical incompetence;
  28. suspected or known uterine abnormality;
  29. pregnancy after assisted reproduction;
  30. risk of fetal abnormality
Pregnancy nuchal translucency only
55704PELVIS or ABDOMEN dating of the pregnancy (by ultrasound) is 12 - 16 weeks and one or more of the following conditions are present:
     
  1. hyperemesis gravidarum;
  2. diabetes mellitus;
  3. hypertension;
  4. toxaemia of pregnancy;
  5. liver or renal disease;
  6. autoimmune disease;
  7. cardiac disease;
  8. alloimmunisation;
  9. maternal infection;
  10. inflammatory bowel disease;
  11. bowel stoma;
  12. abdominal wall scarring;
  13. previous spinal or pelvic trauma or disease;
  14. drug dependency;
  15. thrombophilia;
  16. significant maternal obesity;
  17. advanced maternal age;
  18. abdominal pain or mass;
  19. uncertain dates;
  20. high risk pregnancy;
  21. previous post dates delivery;
  22. previous caesarean section;
  23. poor obstetric history;
  24. suspicion of ectopic pregnancy;
  25. risk of miscarriage;
  26. diminished symptoms of pregnancy;
  27. suspected or known cervical incompetence;
  28. suspected or known uterine abnormality;
  29. pregnancy after assisted reproduction;
  30. risk of fetal abnorm
Pregnancy 12 -16 weeks only
55706PELVIS or ABDOMEN pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, where
     
  1. the patient is referred by a medical practitioner; and
  2. the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
  3. the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
  4. the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
  5. the service is not performed in the same pregnancy as item 55709
Pregnancy 17 -22 weeks only and only 1 per pregnancy
55718PELVIS or ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, where:
     
  1. the patient is referred by a medical practitioner; and
  2. the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
  3. the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
  4. the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
  5. the service is not performed in the same pregnancy as item 55723; and
  6. one or more of the following conditions are present:
       
    1. known or suspected fetal abnormality or fetal cardiac arrhythmia;
    2. fetal anatomy (late booking or incomplete mid-trimester scan);
    3. malpresentation;
    4. cervical assessment;
    5. clinical suspicion of amniotic fluid abnormality;
    6. clinical suspicion of placental or umbilical cord abnormality;
    7. previous complicated delivery;
    8. uterine scar assessment;
    9. uterine fibroid;
    10. previous fetal death in utero or neonatal death;
    11. antepartum haemorrhage;
    12. clinical suspicion of intrauterine growth retardation;
    13. clinical suspicion of macrosomia;
    14. reduced fetal movements;
    15. suspected fetal death;
    16. abnormal cardiotocography;
    17. prolonged pregnancy;
    18. premature labour;
    19. fetal infection;
    20. pregnancy after assisted reproduction;
    21. trauma;
    22. diabetes mellitus;
    23. hypertension;
    24. toxaemia of pregnancy;
    25. liver or renal disease;
    26. autoimmune disease;
    27. cardiac disease;
    28. alloimmunisation;
    29. maternal infection;
    30. inflammatory bowel disease;
    31. bowel stoma;
    32. abdominal wall scarring;
    33. previous spinal or pelvic trauma or disease;
    34. drug dependency;
    35. thrombophilia;
    36. significant maternal obesity;
    37. advanced maternal age;
    38. abdominal pain or mass
Pregnancy >22 weeks only and only 1 per pregnancy

Nurse Practitioners

ItemDescriptionLimitations
57509x-ray - hand, wrist, forearm, elbow or humerus
57515x-ray - hand and wrist, hand wrist and forearm, forearm and elbow and elbow and humerus
57521x-ray - foot, ankle, leg, knee or femur - cannot refer for combination lower extremity
58503x-ray - chest
58506x-ray - chest with fluoroscopic screening
58509x-ray - thoracic inlet or trachea
58521x-ray - left ribs, right ribs or sternum
58524x-ray - left and right ribs, left ribs and sternum, or right ribs and sternum
58527x-ray - left ribs, right ribs and sternum
55036ultrasound - abdomen and urinary tract
55070ultrasound - breast 1 side only
55076ultrasound - breast both sides
55768ultrasound – pregnancy over 22 weeks multiple pregnancy PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, where:
     
  1. dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
  2. the ultrasound confirms a multiple pregnancy; and
  3. the patient is referred by a medical practitioner; and
  4. the service is not performed in the same pregnancy as item 55770; and
  5. the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
  6. the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
  7. the service is not performed in conjunction with item 55718 or 55721 during the same pregnancy

Physiotherapists & Osteopaths

ItemDescriptionLimitations
57712x-ray - hip joint
57715x-ray - pelvic girdle
58100x-ray - cervical spine
58103x-ray - thoracic spine
58106x-ray - lumbosacral spine
58109x-ray - sacrococcygeal spine
58112x-ray - spine; two examinations of the kind referred to in items 58100, 58103, 58106 and 58109
58120*x-ray - spine, four regions, cervical, thoracic, lumbosacral and sacrococcygeal*Items 58120 or 58121(not both) limitation is one per calendar year
58121*x-ray - spine, three examinations of the kind mentioned in items 58100, 58103, 58106 and 58109*Items 58120 or 58121(not both) limitation is one per calendar year
58500x-ray - chest (limited rebate)
57706x-ray - clavicle (limited rebate)
57518x-ray - foot, ankle, leg, knee or femur (limited rebate)
57524x-ray - foot and ankle, ankle and leg, leg and knee or knee and femur (limited rebate)
57506x-ray - hand, wrist, forearm, elbow and humerus (limited rebate)
57512x-ray - hand and wrist, hand wrist and forearm, forearm and elbow or elbow and humerus (limited rebate)
57700x-ray - shoulder or scapula (limited rebate)

Podiatrists

ItemDescriptionLimitations
55836ultrasound - ankle or hind foot
55840ultrasound - mid foot or fore foot
55844ultrasound - assessment of a mass associated with the skin or subcutaneous structures; not being part of MSK system
57521x-ray - foot, ankle
57527x-ray - foot, ankle